Fabio Akira Suzuki

Simulador cirúrgico para treinamento de dissecção do osso temporal

UNLABELLED Temporal bone dissection plays an important role in the training of surgeons; however, they are difficult to obtain. AIM To develop a synthetic replica of the temporal bone for dissection training. STUDY DESIGN Experimental. MATERIALS AND METHODS An acrylic synthetic resin replica was obtained from a human temporal bone. For the evaluation of the method, we selected five ear surgeons to dissect the model in a laboratory of experimental surgery. A questionnaire was filled, assessing external appearance, the simulation of procedures (placement of ventilation tube, mastoidectomy, decompression of the facial nerve and translabyrinthine access to the internal auditory canal) and their final conclusion. RESULTS The evaluation indicated satisfaction in using the model (80%), being more evident concerning the dissection of the mastoid segment of the facial nerve and translabyrinthine access to the internal auditory canal. The placement of a ventilation tube was reasonable for 60% and satisfactory for 40% of them. Mastoidectomy was satisfactory for 60% and fully satisfactory for 40%. CONCLUSION Dissection in this simulator does not replace otologic training in cadaveric temporal bones. However, given the increasing difficulty in obtaining the latter, the development of new teaching tools should be encouraged to continuously improve surgeons.

Avaliação audiométrica de trabalhadores ocupacionalmente expostos a ruído e cádmio

Introduction: Noise is the most common harmful agent present in industrial environments, leading to hearing loss. Besides noise, chemical agents also present in industries, such as solvents and metals lead to hearing loss. Aim: Evaluation of two groups of workers exposed to industrial noise, one of these groups was exposed to cadmium and the other was not, and verify if the concomitant exposition to cadmium and noise is more harmful than the exposition only to noise. Study design: Clinical prospective. Material and Method: It was realized an audiometric research with 36 employees in a metallurgical industry, who were exposed to noise and cadmium fumes at their work environment, from 1994 to 1998. The obtained results in this group were compared to a control group composed by 36 employees, from the same areas of the factory, therefore exposed only to noise. Results: The analysis of the obtained results showed an auditory damage, mainly at the frequencies of 4000 and 6000 Hz, stronger at the group exposed to noise and cadmium. Conclusion: The results showed a probable ototoxic action of the metal when it is associated with noise exposition.

Avaliação dos limiares auditivos com e sem equipamento de proteção individual

The authors evaluated pure tone audiometry with and without specific ear protectors. AIM: The purpose of this case control study was to measure the level of sound attenuation by earplugs. MATERIAL AND METHODS: The evaluation included sixty ears of 30 subjects of both sexes, aged between 20 and 58 years, of various professional activities, with normal hearing thresholds, and following ten hours of auditory rest. The statistical results of pure tone audiometry at 500 to 4000 Hertz with and without specific ear protectors were analyzed. RESULTS: These results were compared with those provided by the ear protector manufacturer. CONCLUSION: The results show that the rate of sound reduction was similar to the manufacturers specifications.

Vestibular evoked myogenic potential: new perspectives in multiple sclerosis

AIM To evaluate vestibular evoked myogenic potentials in patients with multiple sclerosis as method of diagnostic support. STUDY DESIGN Case-control. MATERIAL AND METHOD We studied a group of normal individuals (n=15) and a Studied group (n=15) that comprised patients with diagnosis of multiple sclerosis. Both groups were submitted to vestibular evoked myogenic potential exam. In each ear it was applied 200 stimuli by clicks and repeated for 2 consecutive cycles with the purpose of evaluating reproducibility. The active electrode of surface was put on the superior S++ of sternocleidomastoid muscle and the reference electrode on the anterior border of the clavicle. The individuals were instructed to rotate theirs head to the opposite side to the stimulated ear. RESULTS Vestibular evoked myogenic potential responses were prompt, reproducible and biphasic. The latency of wave P1 and N2 and P1-N2 amplitude showed a higher value in the studied group when compared with the normal group. There was no significant difference when the ears were compared in P1 and N2 amplitude. We noticed that individuals with multiple sclerosis showed no response in 30% of the cases. In evaluating the individuals of the Studied group with otoneurology symptoms and compared with individuals without symptoms, it was observed that P1 and N2 latencies and P1-N2 amplitude were higher in symptomatic cases. CONCLUSION Vestibular evoked myogenic potential was considered a good method of diagnostic support of vestibulospinal tract in cases of multiple sclerosis.

Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

INTRODUCTION The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models) were used daily for at least 6h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION There was improvement in quality of life (Tinnitus Handicap Inventory), with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo

INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular dysfunction. OBJECTIVE To assess whether the performance of the Dix-Hallpike maneuver after the Epley positioning maneuver has prognostic value in the evolution of unilateral ductolithiasis of posterior semicircular canal. METHODS A prospective cohort study in monitored patients at otoneurology ambulatory with a diagnosis of BPPV; they were submitted to the therapeutic maneuver and then to a retest in order to evaluate the treatment effectiveness; all cases were reassessed one week later and the retest prognostic value was evaluated. RESULTS A sample of 64 patients which 47 belonging to negative retest group and 17 belonging to positive retest. Performed the maneuver in all patients, the retest presented 51.85% sensitivity, 91.89% specificity, 82.35% positive predictive value and 72.34% negative predictive value. CONCLUSION The study shows that doing the retest after repositioning maneuver of particles in BPPV is effectual, since it has high specificity.

The Importance of the Individual Adjustments in Sound Therapy

Objectives: The difficulty in choosing appropriate therapy for chronic tinnitus lies in its various forms of impact on the quality of life of patients and requires personalization. The aim of the study was to evaluate the efficacy of the use of sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous drug treatment. Methods: This was a prospective study of 10 patients, 5 male and 5 female, ages ranging from 41 to 78 years with chronic tinnitus who were resistant to previous drug treatments. Bilateral sound generators Reach62 or Mind 9 models were used for at least 6 daily hours for 18 months. Audiometrics testing, pitch, loudness, minimum masking level (MML), Tinnitus Handicap Inventory (THI), Visual Analogue Scales (VAS), and Hospital Anxiety and Depression Scale (HADS) questionnaires were given. Sound generators were used before 1 month and, sequentially every 3 months up to 18 months. The sound generators were individually adjusted, according to criteria of personal complaints in each visit. Results: There was an important reduction in tinnitus in 9 patients using an protocol with a personalized approach, independent of its psychoacoustic characteristics, when THI and VAS were applied. Patients with more than one specific kind of tinnitus concomitantly showed more reduction in pure tone tinnitus. Only 1 patient was indicative of depression in HADS and did not respond to sound therapy. Conclusions: We observed an importance in the individual adjustments in therapy, regardless the equipment used. There was an improvement in tinnitus disturbance and quality of life of these patients.

Pure tone audiometry with and without specific ear protectors

UNLABELLED The authors evaluated pure tone audiometry with and without specific ear protectors. AIM The purpose of this case control study was to measure the level of sound attenuation by earplugs. MATERIAL AND METHODS The evaluation included sixty ears of 30 subjects of both sexes, aged between 20 and 58 years, of various professional activities, with normal hearing thresholds, and following ten hours of auditory rest. The statistical results of pure tone audiometry at 500 to 4000 Hertz with and without specific ear protectors were analyzed. RESULTS These results were compared with those provided by the ear protector manufacturer. CONCLUSION The results show that the rate of sound reduction was similar to the manufacturers specifications.

Case ReportPerilymphatic hyperension

A female 38 year old patient complained of mostly left hypoacusis for the past 4 years; mild bilateral tympanic membrane retraction was present. Audiometry disclosed moderate left conduction loss and slight right conduction loss; immitance testing revealed an A curve and absence of stapedian reflexes bilaterally. The diagnosis was otosclerosis and left stapedectomy was recommended. Perilymph gushed out during microperforation of the platina of the stapes (gusher). The procedure was interrupted and fat from the left auricle was used for orifice tamponing, which stopped lymphorrhage. DISCUSSION